FOURTH AMENDMENT TO ELSEVIER SUBSCRIPTION AGREEMENT WHEREAS, the parties hereto have previously entered into an agreement dated the 17 March 2016, as last amended on 27 March 2017 (the “Agreement”) and wish to amend the Agreement as set forth in this amendment (“Amendment”). NOW, THEREFORE, in consideration of the mutual promises and covenants set forth below, and for such other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree to amend the Agreement as of 30 November 2018, as set forth below and in Schedules 1 and 2. Section 5 Term The term of the Agreement as mentioned in Section 5 of the Agreement is hereby extended and shall continue until 30th June 2019. Consortium acknowledges and agrees that no post termination access rights entitlements shall exist or be accumulated during this extended term. IN WITNESS WHEREOF, the parties have executed this Amendment by their respective, duly authorized representatives as of 30 November 2018. SURFMARKET B.V. (Consortium) ELSEVIER B.V. (Elsevier) Amendment No.: 1-16690065839 1-16690032364 1-16690073204 1-16690065847 Schedule 1 Subscribed Products/Access/Fees SURFmarket B.V. The below Fees are in addition to Schedule 1 of the Agreement. Amendment No.: 1-16690065839 1-16690032364 Subscribed Products – publisher Access 1st Jan 2019-30th June 2019 ScienceDirect® online – sciencedirect.com Elsevier B.V. Complete Freedom Collection · Complete Freedom Collection Fee €6,100,258.59 TOTAL FEES €6,100,258.59 Annex A to Schedule 1 Subscribed Titles SURFmarket B.V. Amendment No.: 1-16690073204 1-16690065847 Product ID ISSN Subscribed Title (online only) 13351 1076-6332 Academic Radiology 13246 0002-9378 American Journal of Obstetrics & Gynecology 13310 0003-9993 Archives of Physical Medicine and Rehabilitation 13049 0749-8063 Arthroscopy: the Journal of Arthroscopy and Related Surgery 13342 1083-8791 Biology of Blood and Marrow Transplantation 07501 1538-4721 Brachytherapy 07647 0015-0282 Fertility and Sterility 13216 0016-5085 Gastroenterology 13360 1547-5271 Heart Rhythm 07551 0360-3016 International Journal of Radiation Oncology / Biology / Physics 13357 1546-1440 Journal of the American College of Radiology 13380 1525-8610 Journal of the American Medical Directors Association 07694 0886-3350 Journal of Cataract & Refractive Surgery 13136 0363-5023 Journal of Hand Surgery (American Volume) 13068 0278-2391 Journal of Oral and Maxillofacial Surgery 13088 0022-5223 Journal of Thoracic and Cardiovascular Surgery 13089 0741-5214 Journal of Vascular Surgery 07539 0958-3947 Medical Dosimetry 07585 0161-6420 Ophthalmology: Journal of the American Academy of 13367 1550-7289 Surgery for Obesity and Related Diseases 07587 0002-9343 The American Journal of Medicine 07610 0003-4975 The Annals of Thoracic Surgery 07583 1053-2498 The Journal of Heart and Lung Transplantation 13372 1553-4650 The Journal of Minimally Invasive Gynecology 07554 0301-5629 Ultrasound in Medicine and Biology The Subscriber may not substitute any withdrawn Subscribed Title identified on Annex A of this agreement Schedule 1.1 Subscribed Titles The Pilot Gold Open Access terms on Schedule 1.1 are replaced and superseded by the below conditions: Pilot Gold Open Access The Authorized Users of the Institutions shall have the right during the period 1st January 2019 to June 30th to submit a total of 1,600 journal articles under the Pilot Gold Open Access for publication to Elsevier and, if accepted after peer review, at no additional cost. If selecting open access under the Pilot Gold Open Access the journal article shall be published under a CC-BY or CC-BYNC-ND license as determined by the submitting Authorized User. The abovementioned amount of 1600 journal articles eligible for the Pilot Gold Open Access under the Agreement consists of: - 1,300 unused journal articles - 300 additional journal articles The eligibility of the above articles for the Pilot Gold Open Access will expire on June 30th 2019, unless the Agreement is renewed in which case any unused amounts shall survive and remain active during the renewal term. Submitting Authorized Users under the Pilot Gold Open Access shall not be required to transfer any copyright in their work to Elsevier, instead submitting Authorized Users grant exclusive rights to Elsevier in the journal article publishing process. The submitting Authorized Users shall have the same rights to reuse the published journal article as those allowed to third party users of the journal article under the selected CC license. The number of journals published by Elsevier which are available for the Pilot Gold Open Access are selected by Elsevier in agreement with the Subscriber and are based upon the domain and NL publishing behavior required to meet the respective quota as described above in Gold OpenAccess journal articles and attached in Schedule 1.2 of this Agreement. Elsevier shall on a monthly basis provide Subscriber a report of the total number of Gold Open Access journal articles published under this Agreement. Elsevier will make available on a semi-annual basis a complete report of all articles (open access and otherwise) published by Authorized Users. Elsevier will not levy article processing charges directly on Authorized Users of the Institutions in relation to the selected Journals under the Pilot Gold Open Access described herein. The aforementioned does not prejudice Elsevier’s right to charge article processing charges from submitting Authorized Users to the extent these fall outside the scope of selected journals under the Pilot Gold Open Access. The Institutions shall ensure that Authorized Users who wish to submit article manuscripts shall identify themselves as being eligible in the course of Elsevier’s publishing work-flow. The parties may adjust the above identifying process where appropriate and amend this Agreement accordingly by means of an amendment in writing. All Institutions will have access to the Elsevier Open Access Platform (“EOA Platform”), which allows such Institutions to validate the eligibility of the author and accept or reject payment of the APC. Validation of eligibility will be the responsibility of the Institution and invoices will be sent to authors at their Institution’s address. The EOA Platform will present the institutional representative with all information needed to validate the article publishing charges, such as the details of the corresponding author, a DOI, article title, journal title, research funding and the APC. When the Institution approves paying the APC, Elsevier will invoice the Institute. Schedule 1.2 Open Access Titles The below list of open Access titles replaces and supersedes Schedule 2 of the Agreement.